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WHO ATTENDS EMERGE?Abuser Education Program

05

1015202530354045

Courts ChildWelfare

Self/OtherAgency

% Clients

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WHO ATTENDS EMERGE?Responsible Fatherhood Program

05

101520253035404550

Courts ChildWelfare

Self/OtherAgency

% Clients

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How do abusive partners present in medical settings?

1) Angry at staff (patient ‘advocate’)2) Angry at partner3) Hovering4) Helpful5) Lurking/Covert (remains in background); using

remote control6) Is another patient (claiming victim status)7) None of the above

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Myth 1:

1) Abusive men are easy to identify:

- Come across as angry, hot tempered, “macho” or having a criminal record

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Reality

Most abusers are never identifiedMost project a different persona outside the family Only a small proportion are arrestedOnly ¼ are generally violent

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Translation:

14-year old boy:

“I am not going to judge him for his actions since he gave me my life, but he is irresponsible”

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Myth 2:

2) Abusers have a problem with anger

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Reality

Domestic Violence is more about control than anger

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Myth 3

3) Batterers lack skills

- anger management skills- communication skills- conflict resolution- psychological awareness

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Reality

Abusiveness is a skill, encompassing

- control- manipulation- image maintenance

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Manipulation

Manipulation tactics often include,- discrediting victim- blaming victim- divide and conquer family/friends - undermining- bargaining- minimizing and denying

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Myth 4

4) Abusers often suffer from low self esteem

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Reality

Narcissism is the more common issue

White and Gondolf (2000) 50% on narcissistic spectrum vs 26% on insecure/dependent spectrum

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Myth 5

5) The majority of abusers have mental health problems

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Reality

Most do not have mental health problems.Gondolf (2000)

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Personality Profiles

White and Gondolf (2000) MCMI-III profiles of 100 abusers attending batterer

intervention:

• 59% had low personality dysfunction• 23 % had moderate personality dysfunction• 18% had severe dysfunction

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Personality Profiles (con’t)

White and Gondolf (2000)

Low Personality Dysfunction (59% of total):Subgroups1) Narcissistic/conforming style 34%2) Avoidant/depressive style 22%3) Atypical style 3%

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Personality Profiles (con’t)

White and Gondolf (2000)

Moderate Personality Dysfunction (23% overall):Subgroups1) Antisocial disorder 12%2) Narcissistic disorder 6%3) Atypical disorder 5%

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Personality Profiles (con’t)

White and Gondolf (2000)

Severe Personality Dysfunction (18% overall):Subgroups1) Paranoid disorder 8%2) Borderline disorder 4%3) Thought disorder 4%4) Atypical disorder 2%

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Personality Profiles (con’t)

White and Gondolf (2000)Overall Personality Profiles1) Narcissistic/conforming (low) 34%2) Avoidant/depressive (low) 22%3) Antisocial Disorder (mod) 12%4) Paranoid Disorder (severe) 8%5) Narcissistic Disorder (mod) 6%6) Borderline Disorder (severe) 4%7) Thought Disorder (severe) 4%

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Myth 5

5) Abusers who express remorse are more likely to change

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Reality

Abusers commonly attempt to manipulate interveners, with- Denial and minimization- Excuses- Quick fix strategies- Expressions of remorseRemorse and apologies are part of the cycle of abuse

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Excuse-making

Most common excuses used by abusers:

1) “She provoked me”2) “I lost control”3) Good intentions (e.g. “I just wanted her to see

how unreasonable she is”, “Its because I care so much”)

4) Stress, Frustration5) Alcohol or drugs

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Excuse-making

Most Common Excuses:

6) Self-defense7) Jealous rage8) Insecurity9) Being tired10) “It was an accident”

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Examples of “provocation”(from Emerge intake files)

“She won’t keep her mouth shut”“She has a big mouth”“She always has something to say”“She doesn’t talk to me respectfully”“She won’t listen”“She’s not sexual enough”“She was being like a slut”“She doesn’t respond quickly enough”

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More examples of “provocation”

“She’s too stubborn”“She’s not as nice as she used to be”“She jokes around too much”“She was battered in her first marriage”“She just so stupid”“She nags, nags, nags”

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Award for most Excuses

Description of violent incident:“I grabbed her and pulled her arm and

threatened to kill her”What was your reason for doing this?

“I was drunk and I was sleeping at two in the morning when the incident started. I felt rejected. I was angry and drunk. She pushed my arm after I touched her and I lost control”.

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Myth 6

6) It the violence has only occurred once, there isn’t a pattern

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Reality

Most often, the first incident that comes to light isn’t the first incidentBoth the victim and the abuser may be minimizingThere may be a prior history of nonphysical abuse

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Myth 7

7) Abusers don’t change

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Reality

Outcomes of abuser intervention programs are quite positive

- program completers are 2-4 times less likely to re-offend

- In Massachusetts, outcomes for certified batterer intervention programs are better than anger management programs, and substance abuse only interventions

- Outcomes are enhanced with strong support of referral sources

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Myth 8

8) Just because a person has abused his partner doesn’t mean he is a bad parent

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Reality

There are two important aspects of parenting:1) How you treat your children2) How you treat the other parent of your children

Children are greatly affected by both of theseBoys who grow up witnessing their fathers seriously abusing their mothers are 10 times more likely to grow up to become abusers --M.Strauss

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Interview Protocol

Should ideally involve full psychosocial assessment

Mental and physical health historySubstance use historyEducation and Occupational AttainmentIsolation and Social SupportFamily HistoryCriminal History

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Interview Protocol

Should include history of current/most recent relationship

Eg. GenogramTimeline, including,

Acts of alleged abuse, child welfare and police involvement, separations, significant events

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Assessment of abusive behavior

Tools might include:

Controlling and Violent Behaviors (Emerge)Relationship History (Emerge)Conflict Tactics Scale (Straus)Tolman PMWI ScaleMarshall Scale

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Abuse Assessment

Use tools at end of interview after doing enquiry about alleged abusive behavior

Two basic approaches: 1) Direct approach: ask him to describe his

version of what happened, then proceed to asking about prior and subsequent incidents of admitted or alleged similar acts

2) Indirect approach: ask him to describe how he handles arguments, conflicts, what he does when he is angry, upset, frustrated, then ask follow-up questions to explore details

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Assessment of Abuse

Direct Approach: ask follow-up questions about specific kinds of physical and verbal abuse:

What about hitting? (Was this a slap or with a closed fist?)

Grabbing? (Where did you grab her?)Pushing? (Where did you push her? Did she fall

down or onto something?) Throwing things: (What did you throw? Did you hit

her with it?)Damaging things: (Walls? Windows? Your own or

her possessions? Telephone?)

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Assessment of Abuse

Banging table? Slamming doors?What’s the worst it has gotten? What about choking?Have you ever used a weapon?(if not identified), What about your fists?, Your car?Have there been any injuries?Have you ever made threats? (What is an example

of what you said?)

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Assessment of Abuse

Do you think (partner’s name) has ever felt intimidated or frightened by any of your behavior?

How so? How do you think it has affected her?

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Assessment of Abuse

How many times have these things happened?When was the last time? How about the time before that?(with each described incident) Did any of the

children witness or hear it? (How so?)Do you think the children knew about it? (How so?) How do you think it has affected them?

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Assessment of Abuse

How about yelling?Swearing? (What specific words?)Name-calling? (What names?)Criticisms? (What are some examples?)How often have these occurred?Do you think the children witnessed or overhead it?How do you think it has affected them?

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Assessment of Abuse

Indirect approach: (Enquire about ways of handling conflict, frustration, anger)

How do you handle conflicts between you and your partner?

(if not identified, prompt with): Do you ever raise your voice?, Criticize her?

How do you handle frustration? (Can you give an example?)

(if not identified): Do you ever yell? Leave?

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Assessment of Abuse

How do you handle when you get angry?(if not identified): Do you ever raise your voice?, Criticize

her? Do you leave the house or the room? Have you ever done anything physical?(if not identified) How about slamming a door? Banging the

table? Pushing? Hitting? Throwing something? Have you ever made a threat?(for all identified incidents) How often has this happened?,

When did this occur? Were there any injuries?, Was this incident witnessed or overhead by children?

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Assessment of Abuse

Access Third Party Sources, including

Police ReportsCourt recordsRestraining Order ApplicationsVictim affidavitsCriminal RecordTreatment Records

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Indicators of Dangerousness

1) Past Attempts or Threats to kill 2) Suicide threats or attempts3) Past use of weapons4) Frequent abuse of substances5) Stalking

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Indicators of Dangerousness

6) Extreme jealousy or possessiveness7) Obsessive thinking8) Depression9) Past threats to abduct or kill children10) Prior strangulation, serious acts of

violence

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Danger Assessment Tools

Violent Risk AssessmentDomestic Violence Screening Instrument (DVSI)Spousal Assault Risk Assessment (SARA)B-SAFER Danger Assessment (DA)

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Effective Treatment for Abusers

Certified Batterer Intervention Programs in MA• 14 certified programs• 40 weeks duration• Provide outreach and confidential communication with

victims• Provide written progress reports• Provide in depth education and individualized feedback• Identifies and makes recommendations to address other

problems, eg mental health, substance abuse, parenting• Please coordinate referrals with BMC Domestic Violence

Program when victim and/or abuser is a BMC patient or employee

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Inappropriate Treatment for Abusers

Couples or family counselingAnger ManagementIndividual Psychotherapy that focuses

primarily on individual psychopathogy, childhood factors, marital communication, substance abuse